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Term used to denote a decrease in all components of a WBC, including granulocytes, monocytes and lymphocytes...
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Leukopenia
Term to denote a deficiency in neutrophils, eosinophils, neutrophils, and basophils...
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Granulocytopenia
Which components of white blood cells counts are closely monitored as a good indicator of a patient's risk for infection?
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Neutrophilic granulocytes
__________ is the term for a reduction in neutrophils.
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Neutropenia
What is considered severe neutropenia?
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A count less than 500 per microliter
What is the normal range for neutrophils per microliter?
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4000-11,000
What are the three components for determining the clinical significance of neutropenia?
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-the rapidity of the decline, - the degree of neutropenia -the duration
What factors, coupled with neutropenia, caused an increased risk of a serious infection?
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Being older than 60, having an existing infection, having diabetes, being in the hospital
What is the most common cause of a neutropenia?
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Iatrogenic effects from medications used to treat other conditions like cancer or autoimmune conditions
What causes the clinical manifestations of infection to be missed in patients with neutropenia?
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Typically, the normal s/s aren't present due to a reduced phagocytic response. So, the normal redness, swelling, warmth, fever, pus formation, etc. is absent.
What are the signs and symptoms that require an immediate response if a patient has neutropenia?
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Any fever, sore throat, dysphagia, ulcerative lesions on the cheeks or throat, diarrhea, rectal tenderness or rectal/vaginal itching, vaginal discharge, SOA or a non-productive cough.
What organisms are commonly responsible for systemic infections in patients with neutropenia?
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They are usually normal flora like Staphylococcus aureus, candida or aspergillus. Reactivation of herpes zoster or herpes simplex are also common.
What are the primary diagnostic studies for neutropenia?
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WBC and a bone marrow aspiration/biopsy
What are the major nursing responsibilities related to neutropenia?
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Strict handwashing, visitor restriction, private room, monitor for s/s of an infection (temp 100.4 and up), collection of cultures if warranted, administration of antibiotics.
A patient with neutropenia has a developed a fever and you have taken serial blood cultures and sputum samples. The lab says it will take about 2 hours to process the gram stains to guide therapies. What is your priority at this point?
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Administer antibiotics. They have to be given within an hour of the onset of fever. Broad spectrum antibiotics via IV are usually ordered.
Cephalosporins are common medications given to patients with neutropenia that have developed a fever. What are the common side effects of this type of drug?
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Rashes, fever, pruritis
Aminoglycosides are commonly prescribed to patients who have neutropenia that have developed a fever. What are two common side effects that a nurse should monitor for?
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Ototoxicity and nephrotoxicity
What type of organism is typically the cause of an infection in a patient with neutropenia of a long duration?
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Fungal, the longer the neutropenia, the greater the risk of a fungal infection
Neupogen/filgrastim and Neulasta/pegfilgrastim are G-CSF medications that are commonly given to patients with neutropenia to stimulate the production and function of _________.
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Neutrophils
Leukine or Prokine (sargramostim)are GM-CSF medications that are given to patients with neutropenia to stimulate the production of _________.
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Monocytes and Neutrophils
What is the most important factor for reducing infections in a neutropenic patient?
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Handwashing by any and all persons who come into contact with the patient.
What are some neutropenic guidelines that are commonly employed for a patient with prolonged neutropenia, like a patient who has had a bone marrow transplant?
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-Avoiding tap water, fresh fruit, fresh vegetables -prophylactic antibiotics and antifungals.
What are some teaching points for a patient with neutropenia to manage their care from home?
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-Wash hands! -Notify the doctor if they develop a fever, chills, or feel hot, develop redness, swelling, discharge, new pain, changes in bowel habits, cough, sore throat or blisters -avoid crowds, avoid raw foods like shushi or Caesar salads, blue chees
You have an elderly patient with neutropenia. They have suddenly become confused and are exhibiting signs of delirium. What illness should you suspect?
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Pneumonia. Elderly individuals often develop delirium instead of a cough due to age related changes.
T/F Patients with neutropenia should not have fresh flowers or plants in their room.
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True. They can introduce pathogens to the patient.
__________ is a group of related hematologic disorders characterized by a change in the quantity and quality of bone marrow elements. Peripheral blood cytopenias and hypercellular bone marrow exhibiting dysplastic changes are hallmark findings.
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Myelodysplastic Syndrome (MDS)
What age group is most likely to be diagnosed with myelodysplastic syndrome?
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People aged 60 and up
Why is myelodysplastic syndrome called a clonal disorder?
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Some bone marrow stem cells continue to function normally while others, called a specific clone, do not
How is myelodysplastic syndrome (MDS) different from acute myelogenous anemia (AML)?
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AML dysplastic cells show little maturation whereas MDS cells always display some degree of maturity.
What is the clinical picture of a patient with myelodysplastic syndrome?
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MDS is usually diagnosed when trying to determine the cause symptoms caused by neutropenia, anemia or thrombocytopenia (fatigue, easy bruising, sensitivity to cold, etc.).


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